This application for a Mentored Patient-Oriented Research Career Development Award (K23) is designed to support a period of training to the candidate, a doctorally-prepared nurse who is an Assistant Professor in the School of Nursing at The University at Buffalo, the State University of New York. The primary aim of the proposal is to identify electrocardiographic (ECG) markers of sudden cardiac death (SCD) in ischemic cardiomyopathic patients. The study will enroll patients who have had a prior myocardial infarction (Ml) and poor left ventricular function. A high resolution (1000Hz sampling) 12-lead ECG obtained and analyzed for both resting and dynamic changes including myocardial ischemia (ST segment) and repolarization abnormalities (T wave). The candidate's extensive training in physiological nursing has focused on ECG studies of hospitalized patients with acute coronary syndromes (myocardial ischemia). Thus, the candidates' strengths in electrocardiography prepare her well for the proposal while expanding her expertise to analyze repolarization abnormalities in ambulatory patients with chronic cardiomyopathies. This K23 will allow the candidate, guided by her mentor John M. Canty Jr., MD, to develop additional skills needed in the research design and methods, statistical methods, scientific writing and grantsmanship. A variety of formal and informal didactics are planned throughout the funding period to maximize the candidate scientific growth. The majority of the award will be devoted to the supervised implementation of a prospective observational study that is intended to electrocardiographically predict the likelihood of sudden death in patients at greatest risk. The skills, training and data obtained from this K23 award will be used to support the candidate's development of an R01 application. In regard to public health, Medicare and Medicaid guidelines for implantable cardiac defibrillator (ICD) implantation include these same patients, those with a prior Ml and poor left ventricular function. While supported by research, the effectiveness of ICD implantation is of concern because (1) it fails to identify over half of the SCD events, (2) the high cost associated with this therapy and (3) the physiologic effects of stress noted in ICD patients include depression, anxiety, anger and hostility. Therefore, developing an approach to identify ECG changes associated with a high risk of arrhythmic death could markedly improve accurate patient selection for ICD therapy.